Implementing Health Reform (January 28 update). On January 15, 2016, the Marketplace made available a new tool on to help taxpayers with completing form 8962 to reconcile their advance premium tax credits or form 8965 to determine whether they qualify for the affordability individual responsibility exemption.

The tool allows taxpayers to find, for both 2014 and 2015, how much the second-lowest cost silver plan would have cost in their location for their family. Taxpayers may need this amount to calculate the premium tax credit for which their household was eligible. The tool also allows taxpayers to determine how much the lowest-cost bronze plan in their location would have cost, and thus whether health coverage was affordable for purposes of the affordability exemption to the individual responsibility requirement. Taxpayers can print, save, or email their results.

January 27 update. On January 27, 2016, the Centers for Medicare and Medicaid Services (CMS) released its open enrollment snapshot for week 12 of the 2016 open enrollment period, covering January 17, 2016 to January 23, 2016. During week 12, 144,971 individuals selected plans through the enrollment platform. This increased net plan selections by 103,172 to a total of 8,939,274 for 2016 to date. The next update covering the last days of open enrollment is likely to report much higher numbers.

For the 2016 open enrollment period, CMS is offsetting new plan selections during a reporting week with insurer and consumer-initiated cancellations during the same week. This should result in a closer correlation between weekly reported plan selections and the final report on effectuated enrollments than was true last year when plan cancellations were not subtracted from plan selections until the effectuated enrollment report was released.

CMS released its November 2015 Medicaid and CHIP enrollment report. Medicaid and CHIP enrollment as of the last day of the November 2015 reporting period stood at 70.8 million, including 29.3 million children. Medicaid enrollment has increased by 14.1 million since October 2013 for the 48 states reporting both 2013 and 2015 data. Enrollment has increased by 34 percent in states that had implemented Medicaid expansion as of that date, and by 10.1 percent in states that had not.

Original Post. On January 25, 2016, the Congressional Budget Office (CBO) released The Budget and Economic Outlook, 2016 to 2026. The report does not update completely the Affordable Care Act (ACA) estimates found in the CBO’s March 2015 Baseline Report (a complete update will not occur until this March’s report), but it does provide some new information.

The CBO had estimated in its March 2015 baseline report that 21 million individuals would be covered through the marketplaces by 2016. Enrollment has been much lower than projected, a fact noted frequently by ACA critics. The January 25, 2016 report clarifies that the 21 million number had included 15 million who would be covered through the marketplaces with premium tax credits and an additional 6 million who would purchase unsubsidized coverage through the marketplaces.

The CBO now projects that 13 million will be covered through the marketplaces for 2016, including 11 million with subsidized coverage and 2 million without. Half of the 8 million enrollee discrepancy between the March 2015 and January 2016 enrollment numbers is due to a reduced estimate in the number of individuals projected to enroll in the marketplaces without subsidies.

The CBO expects that most of these individuals will now purchase coverage directly with an insurer. The CBO also dialed back its projections for marketplace enrollment for 2015 from 11 million to 9.5 million, with the difference entirely due to a reduction in the projected number of unsubsidized enrollees.

The CBO’s projection of 13 million marketplace enrollees is still higher than the 9.4 to 11.4 million that the Centers for Medicare and Medicaid Services (CMS) project will be covered by the end of 2016, but 2016 enrollment is so far coming in at the high end of the CMS projections, so final enrollment might be somewhere in between the CBO and CMS estimates. Reduced enrollment will, of course, reduce the cost of the program — the CBO projects a reduction of $7 billion over the next 10 years.

While the CBO has reduced short-term marketplace enrollment growth projections, it is increasing its projections of the growth of the Medicaid program. Medicaid spending grew by $48 billion (or 16 percent) in 2015, after increasing by $36 billion (or 14 percent) in 2014. Enrollment of newly eligible individuals grew by 55 percent between 2014 and 2015, from 6.1 to 9.6 million. The CBO projects Medicaid spending to increase by 9 percent from 2015 to 2016, but only expects one million additional monthly enrollees. CBO is increasing its 2025 projection for Medicaid enrollment under the ACA expansions from 11.5 to 14.5 million, and its 2025 projection for increased spending for these enrollees in 2025 from $97 to $114 billion.

The CBO does not project in its January report how many people are or will remain uninsured. Reduced expectations in marketplace enrollment could increase the number of uninsured, but increased Medicaid enrollment and off-exchange individual market enrollment would reduce it. The CBO report also notes that the unemployment rate is projected to fall to 4.5 percent in 2016, below its “natural rate” of 4.8 percent. This would mean that more people have employer coverage, further reducing the number of the uninsured (and explaining some of the slack in marketplace enrollment.)

The report notes the effect of the moratorium on Affordable Care Act (ACA) taxes in the budget bill on revenues — a reduction in the health insurance fee from $11 million in 2016 to $1 million in 2017 and further reductions from the delay of the excise tax on high-cost health plans and the medical device tax. This is only a fraction of the $425 billion in increased revenues and $324 billion in increased outlays that CBO projects to result from the 2016 Budget bill over the next 10 years. The CBO projects that a repeal of the three health care taxes would reduce further revenues by $256 billion over the next decade.

The CBO report continues to project that the ACA will result in reduced labor force participation, specifically because it increases the marginal tax rate for high-income employees and the effective tax rate increase for individuals who lose Medicaid or health insurance subsidies. The CBO also notes that a number of other factors, such as the aging of the population and the lingering effects of the recession, will also depress labor force participation, but that strong employment demand will offset these forces.